(subtle music) - [Dan Voiceover] Minnesota, and actually throughout the United States, the Dental Associations is a sponsor of what's called A Mission of Mercy.

And these events generally take place in a field house or a large community center.

And they'll may see over a thousand patients in like three or four days.

- I came out to get my front teeth done.

I lost them due to a pill that I take for seizures.

- I've broken a front tooth, and I'm also missing a few front teeth, and I'm hoping to get them fixed because my son is getting married and I would like to smile at his wedding.

- I rarely seam to smile.

I'm around a lot of people and my job requires me to do that.

And so I need you to do something.

- When we look nationwide at all of the medical healthcare needs that people have unmet dental needs is the greatest need.

- Low resource families do not have the opportunity to access dental the way population with resources does, because they can't find a dentist who accepts their insurance.

- Missions of Mercy are wonderful things.

The amount of care that's provided is great but the day after these folks still need to be followed up and cared for.

What we really need is a system in the state of Minnesota, so we don't need to have Mission of Mercy.

- And that's one of the issues that we've been trying to break down is how do we open wider the door to access for dental care?

How do we make sure that everybody can get it?

(subtle music) - [Narrator] Most Minnesotans are aware of the crisis in healthcare.

It's a high stakes game and the cards can feel stacked for the chronically ill or under-insured.

But there's a lesser known dilemma that we ignore at our peril.

The crisis in oral health care.

The current delivery model works very well for healthy, wealthy, compliant people, while failing low income children and families, older adults and people with special needs.

The harsh reality is that Minnesota ranks near the bottom of States for rates of Medicaid reimbursement.

As a result, many Minnesotans can't find a dentist that will treat them.

- Say aah.

- Aah.

- [Narrator] But there is cause for hope.

Minnesota has a dedicated network of critical access dental providers, finding innovative ways to expand care while reducing costs.

They stand ready to meet Minnesota needs, but need targeted state investments to improve dental health.

What would it take to make dentistry painless for all Minnesotans?

(subtle music) - Good morning, Apple Tree Dental.

- We're all good and your teeth are clean.

- [Narrator] Apple Tree Dental is one of the non-profit critical access dental providers, whose mission is to help uninsured or under-insured Minnesotans overcome barriers to care.

- that feels really, really clean.

- [Neal Voiceover] It's, you know, it's really just dentistry but it's dentistry for a different population.

- There you go.

- [Neal] It's dentistry for people who have access challenges, who have special needs, and sometimes just financial barriers.

It's still dentistry, its still caring for people.

- Without Apple Tree being here, there'd be a lot of people that would just be kicked right to the wayside.

- [Dan Voiceover] Apple Tree has eight centers throughout Minnesota, including six in greater Minnesota and two in the Twin Cities area.

- We not only serve patients that come into our clinics which is what most people probably imagine.

(car engine revving) But we also have teams that go out using mobile delivery systems and tele-health.

Then they go out to places where people that really need dental care but can't get it.

Where they live, like in nursing homes, Headstart centers, schools, variety of different locations, where we can reach people that struggle to get the dental care that they need.

(subtle music) - When you look at surveys from people as to why they don't go to the dentist, finances is the number one issue.

- When you start talking about going to the dentist and you have to wait two months, three months to get in to see a dentist.

I mean, it's like, what's more important, you know, my teeth or my house, you know my teeth or some food, you know what I mean?

- Disease hits more low income families.

It's their ability to get healthcare insurance, and whether that insurance they'll be accepted by a dentist.

- For people who get their dental coverage through Medicaid they have to limit themselves to going to Medicaid participating providers, very few dentists participate in Medicaid because often Medicaid pays much lower rates than what the dentists typically charge for charges for services.

- Less than 40% of all dentists nationwide are willing to accept Medicaid patients because of the low reimbursement that they receive for those services.

- [?]

Here in Minnesota a state known for its medical technology and care, you might expect the rate to be higher.

The Minnesota Medicaid reimbursement rate puts us consistently among the very lowest of the 50 states.

- Providers are paid poorly and unfortunately that does lead to many dental providers making the hard decision to either participate or not participate in the public assistance program.

And that leads to an access to care issue.

And providers aren't readily stepping up because of the economics involved.

- [Narrator] Two thirds of Minnesota dentists participate in the Medicaid dental program, even though it costs them on average, more than $30,000 to do so.

(subtle music) A visit to Fergus Falls, Minnesota, illustrates how critical access dental providers like Apple Tree are collaborating with rural communities to solve this problem.

- Hi.

I'm here for Karma they get her set up another appointment.

- [Narrator] The Fergus Falls clinic provides an essential service to the community, far more than a thousand names on a waiting list to be seen here.

- [Michael Voiceover] Fergus Falls is really typical of a lot of rural communities in Minnesota in that it has an aging population struggling to get care, and recent immigrants that are working there, as well as a lot of low-income people that live in the community that depend on medical assistance for their health care.

- I get disability and SSI when you're living on 700 and some dollars a month, and have to pay everything, you need to have a place where you can go and get treated.

- You're right in here, you get the big chair.

- [Narrator] The Fergus Falls clinic is typical of Apple Trees approach.

Both in the population served and in how the clinic got it start.

- The story is always the same.

There was a leader in that community that knew that access to dental care was a big problem - [Narrator] In Fergus Falls, that person was Diane Thorson.

- [Mike] Diane Thorson in her role as the director of public health was really aware of the public health needs in that community.

- We identified many different needs.

One of which was lack of access to dental care.

- We've heard so many stories you know, of the one-year-olds that are already having many cavities, they're painful.

- Many many counties all throughout Minnesota have healthcare shortages, and dental health care shortages are a vast majority in a vast majority of the counties in rural Minnesota.

- Hey guys.

Come on in.

- Good to see you.

- I received a call from her and she asked, you know, Mike what's it gonna take to get an Apple Tree here in Fergus falls?

You know.

- I really want Fergus Falls to be a hub.

- Really it was Diane who gathered all the information and was able to bring in the school, the hospital, the direct care and treatment clinic and the funding sources.

- It's not just one it's many, it's all of those communities organizations working together to establish a plan and put it together and make it happen.

- [Neal Voiceover] Initially, we got started in a mall in Fergus Falls and set up shop there.

- It's pretty well known in the community that this is used to be a mall.

- You can come on back with me.

- Oh really?

- Yeah (laughs) - [Neal Voiceover] It's a space that we've definitely outgrown.

It's a confined space, not really well set up for dentistry, there's a lot of issues with the mall here.

But generous people have donated to help Apple Trees cause we've got a new building going up about a mile away and it's gonna be beautiful.

I mean, I'm really excited to practice there.

- We're just waiting on a quick checkup.

Kinda looked at the x-rays earlier and those we're looking good as well.

- I've got you all set to go here and they will be right out for you if you wanna have a seat.

- [Narrator] Despite the outdated building the clinic attracts patients from as far as Fargo, nearly an hour away.

- [Neal Voiceover] The patients we see they're generally humble people.

They're appreciative people.

- We came from Campbell, Minnesota.

It's about a half hour drive just to get the kids teeth cleaned.

There isn't anywhere else to go to the dentist around where we live.

They don't accept our insurance.

Besides this dentist, we would have to drive upwards to two to three hours to go see a dentist.

- Many parents choose either not to take their child to the dentist or to drive them up to three hours to get to the dentist.

And when you're a parent that might be low income and having to take off a job, you might lose your job if you take time off to take your child to the dentist.

(subtle music) - [Narrator] For the most glaring example of the oral health crisis, one need look no further than the nearest hospital.

- There are a lot of folks out there with a significant amount of disease and they've looked to try and find care and have been unable to for so long that they give up, and they wind up going to emergency rooms.

(subtle music) - Patients have nowhere else to go to get their care.

They're in pain, they have swelling.

And so they turn to the emergency rooms.

All the emergency room can do unless it's a severe infection.

All they can do is give antibiotics and pain medications and say find a dentist.

- Once a day there's at least one person coming into the ED with some sort of tooth pain or tooth issue.

So someone comes into the hospital, has an abscess needs it drained in an operating room and an overnight stay in the hospital with IV antibiotics.

You're looking at about $20,000 just for that one intervention.

- The cost of emergency room usage to our society is staggering.

- $50 million a year wasted in Minnesota in emergency rooms for dental problems that should have never been there in a state where we invest only $200 million in all of the dental care for 1.2 million people.

It's crazy wasting $50 million in emergency departments.

(subtle music) (people chatting indistinctly) - [Narrator] Community Dental Care is a critical access dental provider that serves 50,000 Minnesotans a year at their four locations.

Three in the Twin Cities and one in Rochester.

- [Karen Voiceover] The people we serve come from all walks of life, all ages, all kinds of nationalities, and ethnicities.

- [Shivan Voiceover] Our primary the goal is to serve underserved population.

So new immigrant populations, patients who really don't have anywhere else to go.

- Our employees speak 26 languages to reflect the people that we are serving every day.

And we're all about providing culturally competent oral health care and preventive education for people in need.

And there are people with really serious dental disease in our state who really don't have many options for care.

- A lot of our population hasn't seen a dentist if they've immigrated here from the U S perhaps ever.

- One of the things that we encounter on a daily basis that's really, really hard for all of us is seeing children with very serious dental disease.

(soft music) In serious pain, with terrible decay.

- A lot of children get the bacteria that are going to be in their mouth from their parents.

We focus very much on education.

- Well, Grayson, I have a quick question for you.

Is it okay if you show me how you brush your teeth at home?

Can you show me, is that okay?

- So we do a lot of preventive education.

We have community health workers.

We go to about 45 different community to provide preventive education, but also preventive services.

- We have a program designated to educating parents.

We go into schools and teach children and we also have a program for pregnant moms.

- And then it is okay if we put the fluoride varnish on now?

- Okay.

- The kinds of tools we use for the youngest children is really very simple.

It's a toothbrush cleaning the kids' teeth, and then applying a fluoride varnish that goes right on the teeth that can help arrest or prevent the bacteria from starting to take hold.

- So this is a great preventative tool we can use.

It's something that a nurse dental assistant, or a dentist can apply in the field.

So it's a really easy to even small children can kind of tolerate that quick, simple procedure.

(subtle music) - Even within our little county, because we're a large geographic County, our people, they still need to drive an hour to get to Fergus Falls for an appointment.

So, because of that we were really excited about the mobile dentistry option.

- So we're in Breckenridge, Minnesota, our clinic is in Fergus Falls so we're about 40 minutes away.

The patients come to us from this area because they can't get to us in Fergus Falls.

(subtle music) - [Narrator] In eliminating barriers to care.

Apple Tree has pioneered the use of mobile treatment units.

- [Mike] We've partnered with Adec, which is the leading manufacturer of a dental chairs and dental equipment.

And created a whole different way to create the very best dental offices and put them on wheels and be able to put those in place in a headstart center or in a nursing home.

- How are you today?

Good.

Come on in.

We're here in Breckenridge today doing a migrant outreach program.

We come here once a year to see the migrant children that really have no other access to dental care.

So today we're going to be doing tele dentistry.

We will take inter oral pictures of all the teeth.

- [Nurse] Wow.

You have some big teeth in there, buddy.

- The hygienist will document all their findings And then we store that information for the dentist who is by the way, back at the office seeing patients.

So he will at a later date, do the full exam.

- I just check those pictures and try to correlate with the x-rays that we have on those patients.

And we make a treatment plan.

- And then we'll send back information to the parent.

And we'll either come back here to do the restorative work or we'll make sure they get seen at our clinic in Fergus Falls.

(upbeat music) - Tele dentistry Apple Tree is one of the first organizations in the nation to do work on tele dentistry.

(upbeat music) We've been doing that for 20 years now.

And we've pioneered how to do that with new roles for hygienists.

Really recognizing that hygienists are the prevention specialists.

(upbeat music) - It seems that dentistry has taken a long time for the dentist to understand even though they are the head of the team, if they allow all the other professionals in their office to work to the top of their license and deliver care and let them be innovative, that is actually gonna help the whole team.

(upbeat music) - [Mike] Oral health is about prevention.

So who should, who better to be in the front line than a hygienist to be the first point of contact in the community to provide oral health education for people of all ages.

- If we don't address oral health as whole person health, what happens?

It can cause infections, abscesses, and death.

And when we have to treat those patients in the hospital it costs 10 million more dollars to do so than if we would have prevented- - [Narrator] Dr. Erin Westfall is a physician and core faculty member, in the family medicine residency here at the university of Minnesota Mankato.

She divides her time between the university and the Mayo Clinics nearby East Ridge facility, where she helps train medical residents in family medicine.

- Hey Nora.

So this is our dental hygienist today and she's just gonna take care of your teeth, okay?

Is that okay with you?

Perfect.

Thank you.

- [Narrator] She's helped launch a new integrated dental medical practice here.

The new clinic addresses the disconnect that often exists between medicine and dentistry.

- The more we learn about the associations between chronic dental disease and chronic diseases such as obesity, diabetes, and stroke.

We really need to look at oral health as whole person health.

And that means that we need to bring our dental teams and our medical teams together to ensure that we're really caring for the whole patient.

- Your daughter's been brushing maybe a couple of times a day morning and night?

- Yeah, we're real good about morning and night brushing - [Narrator] Families who bring their children in for a routine medical checkup can also be seen by a dentist at the same time.

(subtle music) - We will have patients that are scheduled to see their pediatrician either for an acute visit, for an ear ache, or for a well-child visit.

They come into our clinic and check in and then are brought back to the clinic room by our nursing staff.

- Good job, where does this go?

- [Erin] They're seen by the physician or provider.

And then if needed our dental team can actually come right into the medical clinic room and provide care.

They can do an oral exam, apply fluoride varnish, without even having to move to the procedure room.

- Oh my goodness.

Let's do the tap wise now.

- But if we need to have a cleaning, or x-rays, or do some fillings, we can bring them right around the corner to the dental room.

- Having dental available at that same facility is addressing the unmet need of these children that are not receiving dental care.

They just don't have a dental home and this is a way for them to have a dental home.

- We're all coming together.

So let's have a big cheer and let's cut this ribbon.

(audience applauding and cheering) - [Neal Voiceover] So it's grand opening day today.

It's the culmination of years of work.

We're finally in our brand new clinic here in Fergus Falls, Minnesota.

It's a beautiful facility it's state-of-the-art.

- [Mike] It's just so exciting to see come together and produce this beautiful building with all this capacity.

- [Dan] Over the last few years, 1200 patients were on a waiting list, with this beautiful new building and the new staff that we've brought on, we're gonna be able to start to meet those needs.

(subtle music) - Our partner in this project is the direct care and treatment program and their special care dentistry program.

And they provide services to people with disabilities many of whom actually require hospitalization for general anesthesia.

We can do preventive care restorative care, and we can do it at a fifth to a 10th of the cost of what it costs if they have to go to the hospital.

- And welcome to all the new staff, we have 11 new staff members and we still have more to hire.

- The community of Fergus Falls has done an incredible job of bringing all these partners together.

We have this model out there that can be replicated and it should be replicated.

(upbeat music) - Okay, so you go right in there and this is how you brush your teeth at home.

- [Dan Voiceover] The critical access dental care model invests in more prevention and education.

Bringing care to where it's needed to nursing homes, schools, and head start programs.

Embracing a team approach within practices and across disciplines.

- Can you unzip your jacket for me.

- [Narrator] In integrating dental and medical services, to meet the needs of our underserved populations.

- If we take care of the oral health needs, we can very well have an impact on some of the other chronic illnesses.

- Right now we pay a lot for surgical procedures and we pay next to nothing for preventive procedures or disease intervention procedures.

- One of the best things the state of Minnesota can do is to recognize that dental care is critical to the health and wellbeing of our citizens.

We need to make sure adult dental benefits include periodontal disease coverage, because without that we have people with uncontrolled diabetes and heart disease all getting worse because of gum disease that can be treated.

- I think we have to look at healthcare expenditures collectively or as a whole, as opposed to silos what we pay for drugs, what we pay for medical, what we pay for dental, let's look at what we pay for the patient to keep them healthy and then we can see the ROI.

- The idea that we have the worst investment in Medicaid dental of the 50 States is unacceptable.

And to me, that's unconscionable.

My message is all the resources are here.

We just need to spend them smartly and we can solve this problem.

And it'll make a huge difference in the lives of of 1.2 million Minnesotans that are on Medicaid, and hundreds of thousands more who aren't poor enough to be on Medicaid but who can't access care through the traditional dental system.

(subtle music) - [Announcer] Uncovered is funded by, Apple Tree Dental.